Drs. Taraborelli and Ramoni contributed equally to this work.
Brief Report: Successful pregnancies but a higher risk of preterm births in patients with systemic sclerosis: An Italian multicenter study
Article first published online: 25 MAY 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 64, Issue 6, pages 1970–1977, June 2012
How to Cite
Taraborelli, M., Ramoni, V., Brucato, A., Airò, P., Bajocchi, G., Bellisai, F., Biasi, D., Blagojevic, J., Canti, V., Caporali, R., Caramaschi, P., Chiarolanza, I., Codullo, V., Cozzi, F., Cuomo, G., Cutolo, M., De Santis, M., De Vita, S., Di Poi, E., Doria, A., Faggioli, P., Favaro, M., Ferraccioli, G., Ferri, C., Foti, R., Gerosa, A., Gerosa, M., Giacuzzo, S., Giani, L., Giuggioli, D., Imazio, M., Iudici, M., Iuliano, A., Leonardi, R., Limonta, M., Lojacono, A., Lubatti, C., Matucci-Cerinic, M., Mazzone, A., Meroni, M., Meroni, P. L., Mosca, M., Motta, M., Muscarà, M., Nava, S., Padovan, M., Pagani, G., Paolazzi, G., Peccatori, S., Ravagnani, V., Riccieri, V., Rosato, E., Rovere-Querini, P., Salsano, F., Santaniello, A., Scorza, R., Tani, C., Valentini, G., Valesini, G., Vanoli, M., Vigone, B., Zeni, S., Tincani, A. and on behalf of the IMPRESS Investigators (2012), Brief Report: Successful pregnancies but a higher risk of preterm births in patients with systemic sclerosis: An Italian multicenter study. Arthritis & Rheumatism, 64: 1970–1977. doi: 10.1002/art.34350
- Issue published online: 25 MAY 2012
- Article first published online: 25 MAY 2012
- Accepted manuscript online: 28 DEC 2011 09:30AM EST
- Manuscript Accepted: 20 DEC 2011
- Manuscript Received: 16 AUG 2011
- Gruppo Italiano Lotta alla Sclerodermia (GILS)
- Gruppo Lupus Eritematoso Sistemico (Gruppo LES) Lombardia
- Associazione Lombarda Malati Reumatici (ALOMAR)
To assess fetal and maternal outcomes in women with systemic sclerosis (SSc).
Prospectively collected data on 99 women with SSc from 25 Italian centers were analyzed retrospectively. Women with SSc were observed during 109 pregnancies (from 2000 to 2011), and outcomes were compared to those in the general obstetric population (total of 3,939 deliveries). The maternal age at conception was a mean ± SD 31.8 ± 5.3 years, and the median disease duration at conception was 60 months (range 2–193 months).
SSc patients, compared to the general obstetric population, had a significantly increased frequency of preterm deliveries (25% versus 12%) and severe preterm deliveries (<34 weeks of gestation) (10% versus 5%), intrauterine growth restriction (6% versus 1%), and babies with very-low birth weight (5% versus 1%). Results of multivariable analysis showed that corticosteroid use was associated with preterm deliveries (odds ratio [OR] 3.63, 95% confidence interval [95% CI] 1.12–11.78), whereas the use of folic acid (OR 0.30, 95% CI 0.10–0.91) and presence of anti–Scl-70 antibodies (OR 0.26, 95% CI 0.08–0.85) were protective. The disease remained stable in most SSc patients, but there were 4 cases of progression of disease within 1 year from delivery, all in anti–Scl-70 antibody–positive women, 3 of whom had a disease duration of <3 years.
Women with SSc can have successful pregnancies, but they have a higher-than-normal risk of preterm delivery, intrauterine growth restriction, and babies with very-low birth weight. Progression of the disease during or after pregnancy is rare, but possible. High-risk multidisciplinary management should be standard for these patients, and pregnancy should be avoided in women with severe organ damage and postponed in women with SSc of recent onset, particularly if the patient is positive for anti–Scl-70 antibodies.